A Systematic Review of BREAST-Q Outcomes following Reduction Mammoplasty
Christopher D. Liao MD1,3, Joyce Xia BS2, Kelley Zhao BS2, Nikhil Agrawal, MD3, Laurence T. Glickman MD3
1Division of Plastic and Reconstructive Surgery, Stony Brook Medicine, Stony Brook, NY. Renaissance School of Medicine at Stony Brook University, Stony Brook, NY. Long Island Plastic Surgical Group PC, Garden City, NY
Background: Reduction mammoplasty is among the most frequently performed plastic surgery operations worldwide. Numerous patient-related outcome measures have been utilized to evaluate satisfaction following reduction mammoplasty; however, comparison of outcomes is challenging due to heterogeneity across surveys. The BREAST-Q has become increasingly utilized, offering valuable evidence-based data that helps guide standard of care. Our study aims to evaluate the influence of patient characteristics and surgical factors on BREAST-Q scores for patients undergoing reduction mammoplasty.
Methods: The PubMed database was queried using the following search terms: (("breast q") OR ("breast-q")) AND ("Mammaplasty"[Mesh] OR mammoplast* OR mammaplast* OR (breast n3 reduc*)). Studies reporting pre-operative and/or post-operative BREAST-Q scores following reduction mammoplasty were included. Studies of breast reconstruction, augmentation, oncoplastic reduction, or breast cancer patients were excluded. Univariate analysis was performed comparing mean BMI, age, resected weight, complication rate, pedicle used (superomedial vs. inferior), and incision type (Wise pattern vs. vertical incision) against pre- and post-operative BREAST-Q scores. Spearman's rank correlation coefficients (SRCC) with corresponding p-values were also calculated.
Results: Literature search identified 378 unique articles, of which 14 met selection criteria, yielding 1,816 patients. On average, "Satisfaction with Breasts" increased 52.1 +/- 0.9 points (p<.0001), "Psychosocial Well-Being" increased 43.0 +/- 1.0 points (p<.0001), "Sexual Well-Being" improved 38.2 +/- 1.2 points (p<.0001), and "Physical Well-Being" improved 27.9 +/- 0.8 points (p<.0001). Positive correlations were identified between mean age and pre-operative sexual well-being (SRCC +0.61, p<.05), BMI and post-operative satisfaction with breasts (SRCC +0.53, p<.05), and resected weight and post-operative satisfaction with breasts (SRCC +0.61, p<.05). Negative correlations were identified between BMI and pre-operative physical well-being (SRCC -0.78, p<.01), superomedial pedicle usage and post-operative physical well-being (SRCC -0.67, p<.05), Wise pattern incisions and post-operative sexual well-being (SRCC -0.66, p<.05)/physical well-being (SRCC -0.70, p<.05), and vertical incision and post-operative satisfaction with the NAC (SRCC -0.78, p<.05). No significant correlations were noted with complication rates and inferior pedicle use. Most notably, none of the analyzed characteristics had a statistically significant correlation with the difference between pre-operative and post-operative BREAST-Q scores.
Conclusion: Breast reduction surgery consistently improves patient outcomes according to the BREAST-Q. Although either pre-operative or post-operative scores may be individually influenced by BMI, resected weight, pedicle used, or incision type, these variables demonstrated no statistically significant effect on the average change of these scores. Taken together, the data suggests that breast reductions provide substantial improvement in patient-reported satisfaction regardless of any patient-specific or surgical factors.
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